How I did it: Carlene Oleksyn explains how she implemented the ‘Pharmacist-First’ workflow

In the Pharmacist-First workflow, also called “P-First” (P1st) workflow, pharmacists are seated at semi-private intake desks, facing a patient chair so they can assess patients as they present to the pharmacy. All tasks that don’t require a pharmacist’s licence are assigned to other staff. P1st workflow is not the same as a pharmacist-led clinic or appointment-based models with pharmacists providing care in an office setting (though these services are also provided by my team). P1st is the pathway the patient and their prescription(s) take through our pharmacy. Why did I do it? P1st is best practice. It is nearly impossible to find and resolve drug-related problems (DRPs) with only a patient profile and a prescription hard copy in front of you. Assessing the patient (not just the patient’s file) and shared decision-making with them are essential. Best pharmacist care requires that we work with the patient, engaging them in their own care and decision-making, taking responsibility for drug therapy decisions and collaborating with other care providers. To do this we need to be talking with patients when they present, assessing their medications, chief complaints and chronic disease therapy. The P1st model has been studied and has demonstrated positive patient outcomes.1 P1st is the most efficient workflow. If a pharmacist is on the back end or “final check” position in workflow and they do discover a DRP, the prescription has already been entered, prepared and checked, and the patient has waited. Then the team must go through the entire process again to fix the problem and the patient waits yet again. This model is a highly inefficient use of everyone’s time. P1st is best for business. Being up front with the patient allows pharmacists to identify gaps in care which are opportunities to provide needed services. When a pharmacist is up front with patients, medication reviews are natural, follow-ups happen automatically and gaps are addressed for minor illness prescribing. Patient adherence also increases, leading to prescriptions being filled more regularly. Patients are so appreciative of this kind of pharmacist care that word- of-mouth referrals and transfers automatically increase.How did I do it? First, I designed a pharmacy space that is open, making it easy to greet patients as they enter. I started with only one intake station, but prioritized having chairs for both the pharmacist and the patient. This conveys to patients that we are focused on them. They are not "interrupting our work" but rather they are our work. As my business and my team grew, I expanded to three seated intake stations.Secondly, I focused on leadership. Changing existing practice is hard. Even though you are transitioning to a more efficient and effective model, one that provides greater professional satisfaction and allows all team members to work at the top of their license, change is uncomfortable and causes upheaval. The leader must clearly define why change is happening, work to have all team members on board and support them during the transition and afterwards. Times of stress and added workload can cause a team to revert back to what is familiar and comfortable, but the leader can continually bring the team back to the “why” and redirect the workflow when needed. I always include my team when evaluating how things are going and ask for suggestions on improving efficiency. We also revisit all the moving parts anytime we add a new team member or have staff missing.How you can start Evaluate your current workflow and staff tasks. In traditional workflow, pharmacists are on the back end completing the final check. P1st flips this around and has the pharmacists complete the clinical check first then hand the approved prescription to a pharmacy assistant for data entry and dispensing. This requires a separation of the clinical check and the technical check, leaving the technical check to registered pharmacy technicians (RPhTs) on the back end. Pharmacists also provide counselling at the intake station leaving technical teaching of devices to the RPTs. Data entry, insurance adjudication, dispensing, compounding, final package checks and inventory management are not part of a pharmacist’s role in this workflow, freeing up enormous amounts of pharmacist time. I started P1st without a RPhT as I was building a practice from scratch. I still engaged patients at intake and managed the final check, but as soon as I could afford a RPhT I brought one onto my staff and it was a game changer. Over a decade we have grown to a much larger team with several pharmacists and RPhTs, but regardless of size, this can be done. As Chris Juozaitis (another P1st leader) is fond of saying, “there are no unicorns and rainbows here.” Everyone works hard, surprises happen, but the P1st workflow gives staff greater fulfillment and professional satisfaction by providing them the structure and time needed to proactively engage—and improve the quality of life of—patients walking through their door. 1. So R, Al Hamarneh YN, Oleksyn C, Purschke M, Tsuyuki RT. Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes. Can Pharm J (Ott). 2021 May 27;154(6):376-380.

How I did it: Carlene Oleksyn explains how she implemented the ‘Pharmacist-First’ workflow

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